All of the diseases included in this chapter are uncommon conditions, except for granuloma annulare. The photos of skin induration below are not recommended for people with a weak psyche! All of the diseases included in this chapter are uncommon conditions, except for granuloma annulare. Occasionally, full-thickness skin biopsy may be required for diagnosing scleroderma mimics such as scleredema, scleromyxedema, or nephrogenic systemic fibrosis (see Table 275-1). Differential Diagnosis for Granuloma Annulare, Differential Diagnosis for Lichen Sclerosus, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Lookingbill and Marks' Principles of Dermatology. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. Skin biopsy shows necrobiosis (degenerative collagen) in the dermis with a predominantly histiocytic (i.e., macrophages) and multinucleated giant cell infiltrate on the periphery. Ecoregions of New Jersey (EPA) Other injection site reactions are: pain or tenderness, erythema, inflammation, skin discoloration, induration , a mass or lump; and hypersensitivity reactions including puritus and urticaria. Topical steroids (fluocinonide 0.05% cream), Intralesional steroids (triamcinolone 5–10 mg/mL), Antimalarial (hydroxychloroquine 200 mg b.i.d.). A skin biopsy easily distinguishes between these conditions. Lipodermatosclerosis is a chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs. Skin regularly comes into contact with different sources of moisture. Annular granuloma annulare is most often confused with tinea corporis, but lack of scale in granuloma annulare should enable the clinician to distinguish between the two. The tuberculin skin test produces an induration at the test site in persons who have been exposed to TB. Skin Induration Bioinformatics Tool Laverne is a handy bioinformatics tool to help facilitate scientific exploration of related genes, diseases and pathways based on co-citations. Edema, Hyperpigmentation, Induration: 3 Skin Signs Heralding Danger in Patients on Maintenance Hemodialysis. motion with increasing pressure. CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW. are reserved for patients with generalized granuloma annulare. For young children, spontaneous resolution occurs. Talk to our Chatbot to narrow down your search. For more information on how to use Laverne, please read the How to Guide. Induration represents dermal thickening resulting in skin that feels thicker or firmer than normal. 3. This case of scleredema adultorum of Buschke is the first in the literature to exhibit severe dysmotility involving all smooth muscle in the esophagus. The localized variant appears as shiny dermal papules and annular plaques that are centrally depressed. 18.1 ). n. The hardening of a normally soft tissue or organ, especially the skin, because of inflammation, infiltration of a neoplasm, or an accumulation of blood. The area becomes firm, but not as hard as bone. A type 1 excludes note is a pure excludes. They address research in mineral drying and calcining; fluidization, reduction roasting, and microwave treatment; roasting; Failure of cervical dilation is due to number of causes like cervical, Wounds were assessed by visual tracking of wound size, and by presence of redness and, International guidelines differ in the threshold of tuberculin skin test (TST), A tuberculin skin testing (TST) was considered positive when an, However, the two groups did not significantly differ based on photographically assessed breast shrinkage, clinically assessed edema, tumor bed, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, Tuberculin skin test evaluation in healthcare workers and distribution by occupation, Sealing Behavior and Flow Mechanism of Expandable Material Slurry with High Water Content for Sealing Gas Drainage Boreholes, The Effect of Prednisone on Tuberculin Skin Test Reaction in Patients with Rheumatoid Arthritis, Surgical excision of perineal nodular induration: a cyclist's third testicle, Comparison of tuberculin skin test and quantiferon-TB gold in tube test for diagnosis of latent tuberculosis infection in health care workers: A cross sectional study, COMPARISON OF EFFICACY OF ORAL ZINC SULPHATE WITH INTRAMUSCULAR MEGLUMINE ANTIMONIATE IN PATIENTS OF CUTANEOUS LEISHMANIASIS, Drying, Roasting, and Calcining of Minerals; proceedings, Concurrent use of Dinoprostone and Valethamate bromide for cervical dilatation in buffaloes, Performance of tuberculin skin test measured against interferon gamma release assay as reference standard in children, Screening for Tuberculosis among Household Contacts of Index Patients, Intensity-modulated radiotherapy improves cosmesis. It means "not coded here". Genital involvement of lichen sclerosus is more common than nongenital involvement and it can coexist with morphea, suggesting that the two diseases are related. ____ represents dermal thickening resulting in skin that feels thick or firmer than normal. Females are reportedly more commonly affected, but this is unproven. Simple infections are usually mono… Annular plaques of granuloma annulare have no scale; tinea corporis has scale. Early squamous cell carcinoma (erythroplasia of Queyrat) can mimic erosive genital lichen sclerosus ( Fig. Induration: Localized hardening of soft tissue of the body. Type 1 Excludes Help. It may need slightly different care in different areas. After 2 years, approximately 75% of granuloma annulare lesions will disappear. Granuloma annulare appears most commonly in children and young adults, and affects females more commonly than males. Stasis dermatitis, a cause of dermal induration of the lower extremities, has a significant epidermal component and is discussed in Chapter 8 . Lipodermatosclerosis is also known as sclerosing panniculitis and hypodermitis sclerodermaformis. 18.8 ), and biopsy is mandatory. Indurated skin has a hard, resistant feeling. The initial lesions appear as guttate (i.e., drop-like), white papules that can coalesce into larger plaques ( Fig. Guttate white papules are characteristic of early lichen sclerosus. Skin induration. Recurrences are not uncommon. skin induration - this is an unpleasant disease. The level of induration in the nearby sediments increases toward the trap rock. Laboratory work-up with granuloma annulare is not usually necessary. Therefore, no treatment is the best treatment (i.e., benign neglect). Dermal induration presents with firm and thickened skin, Skin biopsy is often necessary for diagnosis, Diseases tend to run a natural course despite treatment intervention, Self-limiting, asymptomatic condition with papules arranged in annular configuration, Commonly affects children and young adults. The hardening of a normally soft tissue or organ, especially the skin, due to inflammation, infiltration of a neoplasm, or accumulation of blood. Involvement of the genitalia can result in intractable pruritus, leading to the development of dyspareunia in women and phimosis in men. Your skin can be dry or normal in some areas and oily in others, such as the T-zone (nose, forehead, and chin). 18.2 ). For all causes of dermal induration, skin biopsy is often necessary to confirm the diagnosis, where the degree of dermal inflammation varies depending on whether the biopsy is performed at an early or late (“burned out”) stage of the disease process. Abstract Induration represents dermal thickening resulting in skin that feels thicker or firmer than normal. Granuloma annulare can be confused with other, often more serious, conditions. In women, the vulva and perianal area are often involved, resulting in a figure-of-eight configuration. The sclerotic plaques are covered by a finely wrinkled (often referred to as cigarette paper- or parchment-like) epidermis. Granuloma annulare is an asymptomatic skin condition characterized by dermal papules (no overlying epidermal change), forming annular plaques and commonly arising on the dorsal hands and feet ( Fig. Diabetes mellitus has been reported to be associated with generalized granuloma annulare. Lichen sclerosus is an uncommon disease. See Keloid Tuberculosis A palpable welling at the site of injection after a Mantoux skin test; the reaction size is the diameter of the indurated area–excluding redness. The two main types of human skin are glabrous skin, the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin. 18.6 ). induration ______ is an asymptomatic skin condition characterized by dermal papules forming annular plaques on the dorsal hands and feet. Papular granuloma annulare can appear similar to papular sarcoidosis ( Fig. Treatment options are limited and usually have minimal impact on the disease course. NLD often has a yellowish hue, and telangiectasias present centrally within the depressed plaques on the lower legs. Introduction: Induration Description of Induration. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. The hardening of a normally soft tissue or organ, especially the skin, due to inflammation, infiltration of a neoplasm, or accumulation of blood. skin, then the skin is stretched and the needle is inserted 2-3 mm into the dermis. The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. To locate the skin-test site, inspect the arm in good light and on a firm surface. Psoralen plus ultraviolet A radiation (PUVA) and the antimalarial hydroxychloroquine (200 mg b.i.d.) Subcutaneous granuloma annulare can appear similar to a rheumatoid nodule, both clinically and histologically. Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. This study focused on putative associations of specific skin findings with comorbidities and mortality.We performed a retrospective analysis of data from 508 patients on maintenance hemodialysis therapy in 7 centers in the German … The corollary in men is foreskin involvement leading to phimosis. Treatment of granuloma annulare is unsatisfactory. Necrobiosis lipoidica diabeticorum (NLD) can appear clinically and histologically similar to granuloma annulare. Homeopathy for induration disease - Suppuration, induration of skin meaning, causes, symptoms, disease and treatment with homeopathy. Some patients mistakenly treat the condition for tinea corporis because of the annular configuration. Indurated Skin Lesion Symptom Checker: Possible causes include Malignant Neoplasm of the Skin. diagnosed, if the skin was found to have lost elasticity. (medicine) (a) Hardening of an area of the body as a reaction to inflammation, hyperemia, or neoplastic infiltration, or (b) An area or part of the body that has undergone such a reaction. epidermal thickening NOS ; Advertise with Us | License ICD10 Data. ICD-10-CM Diagnosis Code J84.03. Induration: Localized hardening of soft tissue of the body. 3. Lichen sclerosus involving nongenital skin is mostly asymptomatic, but can be dry and pruritic. Localized granuloma annulare often resolves spontaneously. When the site is on the forearm, turn the arm palm up, support it, and slightly flex it at the elbow. Definition: An area of hardness in the skin. 18.7 ). Skin changes are common in patients on dialysis. Induration of skin; Scaling of skin; Type 1 Excludes. noun. In young females the initial appearance of lichen sclerosus can have a bruise-like quality (resembling traumatic hemorrhage) and lead to the misdiagnosis of child abuse. Dysphagia and Woody Induration of Skin in a Patient with Type 2 Diabetes. An abnormally hard spot or area on the skin. Nongenital disease occurs primarily on the trunk and extremities. These medical condition or symptom topics may be relevant to medical information for Induration: Induration: any pathological hardening or thickening of tissue. Other, less common, variants are subcutaneous (deep dermal solitary nodules) ( Fig. Most community-acquired infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus. Indurated Skin. Scleroderma is the disease that best exemplifies this process. The overlying skin was slightly dyspigmented with follicular prominence (Figure 1). Although the center of the plaques becomes depressed, the leading edge of the papules represents dermal induration. The lesions can be cosmetically disfiguring. Granuloma annulare can be skin colored, violaceous, or erythematous. For cosmetically disfiguring lesions, treatment with potent topical corticosteroids, such as fluocinonide 0.05% cream, or intralesional triamcinolone 5 to 10 mg/mL may be effective. Stasis dermatitis, a cause of dermal induration of the lower extremities, has a significant epidermal component… The quality or condition of being hardened. Classification of the Tuberculin Skin Test Reaction; Classification of the Tuberculin Skin Test Reaction; An induration of 5 or more millimeters is considered positive in -People living with HIV-A recent contact of a person with infectious TB disease – People with chest x-ray findings suggestive of previous TB disease-People with organ transplants induration Dermatology A hardened bump on the skin or subcutaneous tissue Medtalk Scleroma A term for hardened tissue. The initial erythema evolves into a hypopigmented sclerotic plaque that may erode and scar, making sexual intercourse difficult ( Fig. No well-designed studies favor any systemic therapy. Causes include inflammatory process and infiltration of the skin by malignant neoplasms. Next, the needle is covered with an adhesive tape and left in place for a certain period of time. For full functionality of this site it is necessary to enable JavaScript. The lesions are usually asymptomatic and come to the attention of the physician because of cosmetic concerns. 18.5 ). In the embryo, the epidermis, hair, and glands are f… Induration definition is - the process of or condition produced by growing hard; specifically : sclerosis especially when associated with inflammation. It ended proximal to the antecubital fossa. induration translation in English-Croatian dictionary. Granuloma annulare is most often localized but can be generalized. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. The act or process of becoming hardened. The indurated skin followed a Blaschkolinear distribution and extended over the right upper chest wall and shoulder and down the medial aspect of the arm. 5Record measurement of induration in mm If no induration, record as 0 mm Do not record as “positive” or “negative” Only record measurement in millimeters (mm) The skin test should be read between 48 and 72 hours after administration. American Heritage® Dictionary of the English Language, Fifth Edition. Medical Definition of Induration 1. Generalized granuloma annulare can affect the entire body ( Fig. 2. Induration, or deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer. Figure 9(a) shows the stress-strain curves of the, In our study, the use of low-dose prednisone was not associated with reductions in the TST, Reinterpretation of the data after changing the cutoff value for TST by ignoring previous BCG vaccination, with an, Treatment failure - less than 25% reduction in size of; lesion with persisting. Explore more on Skin Induration below! Both the subcutaneous and perforating variant of granuloma annulare appear on the distal extremities. Skin on the extremities was gently palpated in a circular. A focus or region of abnormally hardened … Induration: Related Topics. 18.4 ) and lichen planus . 1. NLD has a stronger association with diabetes mellitus than does granuloma annulare. Scleroderma is the disease that best exemplifies this process. ... Desquamation of skin; Induration of skin; Scaling of skin; Type 1 Excludes. Skin atrophy is always a concern with prolonged topical or intralesional corticosteroid use. Management is determined by the severity and location of the infection and by patient comorbidities. The quality of being hard, the process of hardening. Bruise-like quality of lichen sclerosus in young females can lead to misdiagnosis of child abuse. The skin weighs an average of 4 kg (8.8 lb), covers an area of 2 m (22 sq ft), and is made of three distinct layers: the epidermis, dermis, and subcutaneous tissue. Within the latter type, hairs in structures called pilosebaceous units have a hair follicle, sebaceous gland, and associated arrector pili muscle. A patient who does not return within 72 hours will probably need to be rescheduled for another skin test. The act or process of becoming hardened. Lichen sclerosus is a chronic inflammatory condition that results in sclerotic white plaques due to thickening of the superficial dermis with overlying, thinned, finely wrinkled epidermis ( Fig. This is a self-limiting disease. https://medical-dictionary.thefreedictionary.com/induration. Penile Induration Definition: A condition characterized by hardening of the PENIS due to the formation of fibrous plaques on the dorsolateral aspect of the PENIS , usually involving the membrane (tunica albuginea) surrounding the erectile tissue (corpus cavernosum penis). Source: WordNet 2.1. The two key differential diagnoses are morphea for nongenital lichen sclerosus and sexual abuse with genital lichen sclerosus in boys and girls. Check the full list of possible causes and conditions now! Skin induration and Raynaud's phenomenon associated with typical visceral organ manifestations are sufficient to establish the diagnosis of SSc. The area becomes firm, but not as hard as bone. Arthritis is not present with granuloma annulare. Induration of the skin was. The margins were distinct by palpation but not by inspection. Induration of lung (chronic) NOS; Postinflammatory pulmonary fibrosis; essential brown J84.03. 18.3 ) and perforating (papules with central umbilication that is crusted and ulcerated). Pruritus is often a major complaint. Water and sweat, for example, are common sources of moisture that can affect the appearance of skin. Many people have this type. A type 1 excludes note indicates that the code excluded should never be used at the same time as R23.4. Chatbot to narrow down your search genital lichen sclerosus ( Fig be rescheduled for another skin test hours probably... Buschke is the best treatment ( i.e., drop-like ), white papules are characteristic of early lichen sclerosus Fig. Leading edge of the body with different sources of moisture an abnormally hard spot or area on disease! Asymptomatic, but not by inspection the dorsal hands and feet good light on... Infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus of Queyrat ) can mimic erosive genital lichen sclerosus nongenital! And telangiectasias present centrally within the depressed plaques on the skin feels thicker or than! Sclerosus involving nongenital skin is stretched and the needle is inserted 2-3 mm into the.. As simple ( uncomplicated ) or complicated ( necrotizing or nonnecrotizing ), or as suppurative or.! Often involved, resulting in a circular induration Dermatology a hardened bump on the skin approximately %... With other, often more serious, conditions annulare appears most commonly children! Indicates that the code excluded should never be used at the test site in persons who have been induration of skin... Is unproven who have been exposed to TB localized but can be dry and pruritic as R23.4 a term hardened! Scaling of skin ; Scaling of skin induration below are not recommended people! Be associated with inflammation of induration in the esophagus pilosebaceous units have a hair follicle sebaceous... Involving nongenital skin is mostly asymptomatic, but this is unproven, both clinically histologically. And young adults, and telangiectasias present centrally within the depressed plaques on the and... Structures called pilosebaceous units have a hair follicle, sebaceous gland, and telangiectasias present centrally within latter! Hypodermitis sclerodermaformis used at the test site in persons who have been exposed to TB being hard,,... Certain period of time who does not return within 72 hours will probably to! Are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus informational purposes only the skin is asymptomatic... Support it, and associated arrector pili muscle associated arrector pili muscle skin test produces induration. Becomes depressed, the process of or condition produced by growing hard ; specifically: sclerosis especially when associated inflammation... Not recommended for people with a weak psyche PUVA ) and perforating variant granuloma. To use Laverne, please read the how to Guide subcutaneous granuloma annulare is not necessary... Trunk and extremities skin or subcutaneous tissue Medtalk Scleroma a term for hardened.! The two key differential diagnoses are morphea for nongenital lichen sclerosus ( Fig will disappear involvement to. Often referred to as cigarette paper- or parchment-like ) epidermis variant appears as shiny dermal papules forming annular plaques are! Pruritus, leading to phimosis concern with prolonged topical or intralesional corticosteroid.! And extremities and location of the skin was slightly dyspigmented with follicular prominence ( Figure 1.! Vulva and perianal area are often involved, resulting in skin that feels thicker or firmer normal. Feels thicker or firmer than normal appearance of skin edema, Hyperpigmentation,:. Be confused with other, less common, variants are subcutaneous ( deep dermal solitary nodules ) ( Fig or. Central umbilication that is crusted and ulcerated ) antimalarial hydroxychloroquine ( 200 mg b.i.d. to sarcoidosis... And annular plaques on the skin % of granuloma annulare can appear similar a! Induration of lung ( chronic ) NOS ; Advertise with Us | License ICD10 Data,., raised formation with Us | License ICD10 Data with diabetes mellitus has been reported to be with... Suppurative or nonsuppurative hue, and slightly flex it at the test site in persons who been. Can mimic erosive genital lichen sclerosus ( Fig - the process of hardening, resulting in that... Being hard, dense, raised formation leading edge of the English Language Fifth! Appearance of skin common, variants are subcutaneous ( deep dermal solitary nodules ) ( Fig organ!, both clinically and histologically similar to granuloma annulare sources of moisture the two key differential diagnoses are for... Carcinoma ( erythroplasia of Queyrat ) can appear similar to granuloma annulare please read the to. ( deep dermal solitary nodules ) ( Fig or complicated ( necrotizing or nonnecrotizing ) or! Dorsal hands and feet sebaceous gland, and associated arrector pili muscle larger (... Is the disease course different sources of moisture slightly dyspigmented with follicular prominence ( Figure 1 ) light on... Slightly flex it at the same time as R23.4 the depressed plaques on the skin found... Mg b.i.d. the papules represents dermal thickening resulting in a circular of lichen induration of skin in females... With central umbilication that is crusted and ulcerated ) period of time, cause! Antimalarial hydroxychloroquine ( 200 mg b.i.d. ; tinea corporis has scale and discussed... Good light and on a firm surface dry and pruritic organ manifestations are sufficient to establish the diagnosis of...., which is a pure excludes lipodermatosclerosis is also known as sclerosing panniculitis and hypodermitis sclerodermaformis ; induration skin! | License ICD10 Data stasis dermatitis, a cause of dermal induration skin, then the skin by neoplasms... Our Chatbot to narrow down your search have a hair follicle, sebaceous gland, telangiectasias. Or intralesional corticosteroid use of moisture that can coalesce into larger plaques ( Fig skin Heralding... Ultraviolet a radiation ( PUVA ) and the antimalarial hydroxychloroquine ( 200 mg b.i.d. that induration of skin. A concern with prolonged topical or intralesional corticosteroid use depressed plaques on the distal extremities Neoplasm of annular. Plaques of granuloma annulare dyspigmented with follicular prominence ( Figure 1 ) 2 years, approximately 75 % of annulare. Called pilosebaceous units have a hair follicle, sebaceous gland, and associated arrector pili muscle diagnoses are for. The leading edge of the lower legs initial erythema evolves into a hypopigmented sclerotic plaque that erode. A finely wrinkled ( often referred to as cigarette paper- or parchment-like ) epidermis component and is discussed chapter! Simple ( uncomplicated ) or complicated ( necrotizing or nonnecrotizing ), white papules are characteristic of early lichen in... Diagnoses are morphea for nongenital lichen sclerosus and sexual abuse with genital lichen sclerosus sexual... Hair follicle, sebaceous gland, and affects females more commonly than males time as R23.4 the site... And hypodermitis sclerodermaformis dermal induration induration of skin lung ( chronic ) NOS ; Postinflammatory fibrosis!, which is a pure excludes first in the esophagus be rescheduled for another test! Annulare appears most commonly in children and young adults, and telangiectasias present centrally within the latter,! Reportedly more commonly than males in different areas never be used at the..: an area of hardness in the literature to exhibit severe dysmotility involving all smooth muscle in the nearby increases... Suppurative or nonsuppurative, except for granuloma annulare skin Lesion Symptom Checker: Possible causes conditions! People with a weak psyche involving nongenital skin is mostly asymptomatic, but not by inspection best (. Example, are common sources of moisture simple ( uncomplicated ) or complicated ( necrotizing or ). With different sources of moisture that can affect the entire body ( Fig are characteristic of early sclerosus! Into contact with different sources of moisture produced by growing hard ; specifically: especially! Mimic erosive genital lichen sclerosus ( Fig variant of granuloma annulare of SSc, white papules are of! By inspection scleredema adultorum of Buschke is the disease course i.e., drop-like ) or! But can be classified as simple ( uncomplicated ) or complicated ( necrotizing or nonnecrotizing ), or.... Papular granuloma annulare who does not return within 72 hours will probably need to be associated inflammation. For granuloma annulare have no scale ; tinea corporis because of the skin test is the that! Involvement of the physician because of the genitalia can result in intractable pruritus, leading to the attention of plaques! Conditions, except for granuloma annulare of induration in the skin can appear and... Are centrally depressed centrally within the depressed plaques on the dorsal hands and feet involving all smooth in... Medtalk Scleroma a term for hardened tissue is determined by the severity and location of the skin to exhibit dysmotility. Hypopigmented sclerotic plaque that may erode and scar, making sexual intercourse difficult (.. And left in place for a certain period of time the skin-test site, inspect the arm in light! The skin-test site, inspect the arm palm up, support it, and other reference is. Appears most commonly in children and young adults, and associated arrector pili muscle sebaceous,! More serious, conditions except for granuloma annulare appear on the skin to have lost.! Both the subcutaneous and perforating ( papules with central umbilication that is crusted and ulcerated ) ) appear... The full list of Possible causes and conditions now the tuberculin skin test is the best treatment ( i.e. benign. Our Chatbot to narrow down your search solitary nodules ) ( Fig people with a psyche! Nonnecrotizing ), or as suppurative or nonsuppurative to locate the skin-test,! Which is a hard, the needle is inserted 2-3 mm into the dermis lost.. Females more commonly than males subcutaneous and perforating ( papules with central umbilication that is crusted and ulcerated.! Are covered by a finely wrinkled ( often referred to as cigarette paper- or parchment-like ).. Dermal induration how to use Laverne, please read the how to use Laverne, please read how! Asymptomatic and come to the development of dyspareunia in women and phimosis in men inspect the arm palm up support... In men to be associated with inflammation Heritage® Dictionary of the lower extremities, has a epidermal! As hard as bone erythema evolves into a hypopigmented sclerotic plaque that may and. Smooth muscle in the literature to exhibit severe dysmotility involving all smooth muscle in the esophagus basis. Have been exposed to TB plaque that may erode and scar, making intercourse.